cesareans and postpartum mood disorders connection

When Susan* first saw the double pink lines on her pregnancy test, the last thing she thought about was a cesarean section. In fact, she barely paid attention to the information about Cesarean Sections offered during her childbirth class. A friend even assured her a Cesarean Section was easy: 15-20 minutes on the table and then it was over. But delivery for Susan cumilated with an emergency cesarean due to a fever she developed during labor. Her son also stopped progressing as he kept turning his head instead of moving further down the birth canal.

Suddenly, Susan found herself given a chance at two more pushes. Nurses prepped her for surgery after those last two pushes did not produce her son. Scared, confused, and nearly delirious, she was strapped to the surgical table as her arms trembled and shook so much she no longer controlled them. Her son was born within a few minutes, shown to her, then whisked away to be cleaned and checked over. She remained on the surgical table as her uterus then stomach was repaired and closed with sutures. It would be three agonizing hours before she would really meet her son. Even then, the initial glow was overshadowed by the traumatizing birth she just experienced.

As the cesarean rate skyrockets in the United States (USAToday), so do Postpartum Mood Disorder rates. 1 in 8 new mothers experiences a Postpartum Mood Disorder. After asking on Twitter for Moms to share with me if they had experienced a PMD after a cesearean, my direct message box and email inbox flooded with message after message. So many mothers had indeed faced an emergency (in the midst of labor) or last minute planned (prior to any labor attempts) Cesearean. So many other mothers I have supported over the past few years have also had a Cesarean Section. All of this would lead one to think there must be a connection between a cesearean birth and a PMD, right?

Wrong.

As I searched and searched through study after study, they all contradicted each other. One found a correlation but another dismissed it. Another study which reviewed several studies (http://www.psychosomaticmedicine.org/cgi/content/abstract/68/2/321), concluded that “A link between Cesarean Section and Postpartum Depression has not been established.”

Yet here we are.

Rocketing cesarean rates with rising Postpartum Mood Disorder rates. Is there really a lack of correlation? Or perhaps more mothers are bravely raising their voices about their experiences with both Cesarean Sections and Postpartum Mood Disorders, making it appear there is indeed a correlation, even if only anectdoctally at the moment.

There are of course, aspects of a Cesarean birth which would, in my opinion, raise the risk for developing a Postpartum Mood Disorder:

A surgical birth requires a longer & more difficult recovery period: According to Childbirth.org, many mothers average 6 weeks or more to recover from a cesarean. A vaginal delivery can take as little as a few days for mom to be up and about.

Limited bonding opportunities after birth: Unlike a vaginal birth where baby is placed on mom’s chest immediately after birth, most Cesareans do not provide access/bonding between mother and child during the “Golden Hour” (http://www.medscape.com/viewarticle/710137) which interferes with bonding and initial breastfeeding.

Increased risk of trauma: Post-Traumatic & Physical: Mom may have planned her Cesarean. Or Mom may have gone in expecting to give birth vaginally and faced an emergency Cesarean during the course of labor for a number of reasons. Either way, there is an increased risk of both physical and mental trauma with a Cesarean and an emergency Cesarean.

Increased possibility of high risk future pregnancies including Placenta Previa and Accreta. Cesarean deliveries increase the risk of developing Placenta Previa and Accreta with subsequent pregnancies. As the number of Cesarean births rise so do the number of these life-threatening complications which may result in premature delivery, hemorrhaging or another Cesarean birth (planned or emergency). In rare cases Placenta Accreta can be fatal for either mother or baby and/or both. Read here for one mother’s story. (http://abclocal.go.com/ktrk/story?section=news%2Fhealth&id=7727458)

There are several things mothers can do to help improve their chances of a positive outcome after a planned or emergency Cesarean:

Educate yourself about the risks of a surgical birth. Cesareans, bottom line, are surgical births. While they are absolutely necessary in a small percentage of cases, they are used more and more with no justifiable root cause. Advocate for a vaginal birth if at all possible. A good place to start educating yourself is at Childbirth.org (http://www.childbirth.org) While you may not be planning on a Cesarean, you may find yourself facing one during labor. A knowledgeable, educated woman will know her rights, know the risks, and be prepared to discuss them intelligently with her doctor. Involve your partner is this education as well so he/she is ready and able to go to bat for your rights as well.

Check your doctor or midwife’s Cesarean section rate as well as the Cesarean section rate of the hospital at which you will deliver. If you are dedicated to having a vaginal birth, it’s best to choose a hospital or caregiver with a low rate of Cesarean deliveries. A low-rate of Cesarean section can also be indicticative of stronger materntal involvement in your care.

Develop a support team for after-care if you have a cesarean. Clearly this team will be on stand-by if you have a vaginal birth planned. Cesareans limit your ability to: care for other children, do houswork, drive, and may require several doctor’s visits after birth if your incision were to become infected and or separate. You will need a team to pitch in to help with meal preparation, childcare, housework, and possibly even transportation to the doctor as many doctors do not allow Cesarean patients to drive for up to six weeks after surgery.

Discuss your feelings about your childbirth choice with your doctor BEFORE birth. Make sure you are on the same page as your caregiver. You are a team, not a dictatorship. (This goes both ways)

Discuss any history of mental health after birth or in general with your doctor BEFORE birth. Again, this ensures you are both aware of the risks and are ready to deal with them should they crop up in the last trimester or after delivery.

Consider hiring a postpartum doula in addition to a birth doula. A birth doula will support both you and your husband during labor. She does not replace your husband but rather acts as a third (very knowledgeable) party during a important part of your life. Additionally, hiring a birth doula may help avoid many emergency Cesareans (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595013/). A postpartum doula will help at home with light housework, infant care education and care of the mother. You may even be able to hire a doula for little to no cost if she is still in training for her certification. DONA: Doulas of North America or CAPPA: Childbirth and Postpartum Professional Association are two excellent organizations at which you can start your search.

Rest after birth. Follow orders and do not overdo yourself. Now is not the time to re-organize the entire house from top to bottom. You will heal faster if you take the time to rest and let your body heal itself.

Research does not conclusively show a connection between Cesarean sections and Postpartum Mood Disorders but anectdoctal evidence is mounting. A mother who has had a negative experience at birth due to a Cesarean Section may be more likely to develop Postpartum Post-Traumatic Stress Disorder as a result. Many mothers who have vaginal births may develop this as well given that trauma is in the eye of the beholder, meaning that just because medical professionals or someone else does not view the event as having been traumatic but the mother does, then it was clearly traumatic for her. Perception is everything in life.

In an article about Cesarean Feelings, a recent survey by Danielle Elwood and Theresa Shebib (see The Post Cesarean Feelings Survey) was examined. In their survey, 288 mother described their Cesarean experience as wonderful or empowering. In contrast, 976 mothers described their Cesarean experience as either frustrating, traumatic, or disappointing with the highest number of mothers, 384, opting to answer that their experience was traumatic. 861 mothers were surveyed but for this question, they were allowed to choose more than one answer.

Yet no official conclusive link exists between Cesarean Sections and Postpartum Mood Disorders.

Educate yourself about your childbirth choices, make them wisely, and ensure that your mental health stays intact above all else. Self-care is not indulgent when it comes to motherhood, regardless of your childbirth choice, it is an absolute necessity. Self-care starts in pregnancy, continues through childbirth, and beyond. Be sure you are comfortable with the choices you are making and they are made in with the best information available to you. It is your body, your baby, your choice. You deserve nothing but the absolute best.

*name has been changed to protect privacy

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A Guest Post byLauren Hale, a mother of three and survivor of Postpartum Mood Disorders

Lauren Hale, a mother of three and survivor of Postpartum Mood Disorders, sleeps in until 605 am every day. Lauren survives her days on nothing more than Starbucks and sheer grit. She’s sassy, outspoken, and hardly ever takes no for an answer. Unfortunately, her kiddos are just like her and choose to exercise these qualities as she blogs about Postpartum Mood Disorders (http://www.mypostpartumvoice.com). She’s found a cure though – headphones and Pandora. Lauren also hosts #PPDChat at Twitter every Monday at 1pm EST and 830pm EST.

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